Month: June 2016

I had a wonderfully interesting conversation with a favorite friend this weekend. She’s the kind of person who, when she laughs you can’t help but start laughing. She’s unconventional in the best of ways. When my friend moved back into town she was looking for a new gynecologist. So, instead of asking friends or family, she just looked at pictures on the websites of doctors in town. She was looking for someone who was “not too old but looked like they knew what they were doing.”

I could just imagine her perusing through online images of OBGYNs like an online dating site. Well, she picked a doctor and it turned out pretty well for her. But it got me to thinking, how should you choose a gynecologist or any other doctor? Looks? Personality? Experience? Data? Wait time? Office location?

I don’t know that there is a magical answer for this. First, most physicians are more than adequately trained. They have spent thousands of hours in training to get to this point. Will they be perfect? No, we are human. But finding a doctor is probably a lot like finding a house, a spouse or anything else in life. I remember growing up thinking that God was using His laser beams to find me the one and only exact right person to marry and if I missed out I would never find another. But, I DO think finding Pastor Jason is kind of the meaning of grace. More than I deserve. There probably aren’t any laser beams bringing you a spouse. And there probably isn’t a laser beam directing you to the right physician. But, I think you should look for a few key things when choosing a gynecologist or any other doctor.

Do you feel free to ask questions to your doctor? You should be able to be open and honest with your physician.

Does being seen on time matter a lot to you? Often doctors who spend more time answering questions or have a large patient population because of their great care might run behind. You have to ask yourself if it’s worth the wait, so to speak

Do you have a serious/rare illness? Then it’s probably best to find a specialist who is highly regarding and highly skilled. Do your homework. Ask people with the same diagnosis or illness about who they saw and why. Find out if any doctors you are currently seeing would recommend someone for your specific case.

Do you have a gender preference? I would say that gender isn’t a huge issue in choosing a doctor. If your provider is a caring physician who expresses empathy then it shouldn’t matter what their gender is. But, if you are only going to be comfortable sharing your full un-edited medical history with a specific gendered physician then maybe you should consider it.

No, there are no laser beams directing you to the perfect doctor for you. If you’re looking for a doctor to magically fix all your ills in one visit you probably won’t find them. If you’re looking for someone to tell you exactly what you want to hear, you might find them but you might not actually be healthier at the end of the road. But I do hope you find a physician who can be more than gracious to you. Who can listen, guide, and care for you. Who you respect and trust. If you are seeing someone who isn’t caring for you in a way you find beneficial, seek another physician out. I don’t want a patient to continue to see me if they don’t want to continue to be my patient. Because while I find it hilarious that my friend found her doc in the same way you would find a date online, I would hate for anyone to be trapped on a bad date with their doctor.

At lot of medicine is about what we think we understand to be true. We use the best available evidence, if there is evidence available, to help patients make decisions about their care and to manage disease to the best of our ability. (I previously posted on this idea of evidence based medicine.) I think most of life works this way. Our minds compile what we think is the best available evidence to make decisions. Like when I go to the grocery store. Which package of strawberries seems to be the brightest, which milk carton expires latest, what granola bars my kids will eat this month.

But there are some things that we don’t have much evidence for. Sometimes this is because we don’t have much experience or research with the problem. Take, for example, the Zika virus. Although the Zika virus has been around for some time, we have very little experience and research with the virus when it comes to adverse pregnancy outcomes such as microcephaly, miscarriage, and other complications in pregnancy. You see, what was first noticed was an association. A large number of women who had been exposed to the virus or were known to have the infection had babies born with microcephaly, or underdevelopment of the brain. Does association mean causation? No way. So scientists from the CDC and other organizations began to explore how these two things were related. For many other infections a pregnant woman might be exposed to doctors can give a significant amount of information to their patients about the risk to your baby depending on when you are exposed and other laboratory findings. But for Zika we don’t know that information. We have limited data that would say about 1/3 of pregnant women infected with Zika will have some kind of adverse pregnancy outcome.

So what do we do? Well, the CDC says if you’re pregnant just never go outside. (I can hear you laughing all my pregnant ladies.) We tell our patients to use insect repellent with DEET, to avoid travel to Zika infected areas while pregnant or for at least 6 months prior to attempting pregnancy and don’t have sex with men who have been exposed to Zika or have travelled to Zika infected areas if you are pregnant. We have no vaccine; we have no treatment. But, hopefully soon, we will. Researchers will continue to work on how the virus is transmitted, why certain women’s infants are affected, and how to prevent or treat Zika before it becomes an even bigger health concern.

The other issue I’d like to address today that we don’t know much about is gun violence. Oh yes, I went there. You see the CDC has had a self imposed ban on gun violence research since 1996 when its funding was threatened. It has been more than 4 years since Sandy Hook and only a week since the Orlando night club shooting. Two large bills to fund gun violence research have failed to pass. Is there some research out there on gun violence? Sure. But consider this: if you do a PubMed search on Gun violence you will find about 1500 scientific articles or editorials on the topic. If you do the same search on autism, you will find over 34,000 articles on the topic. Is autism research important? Absolutely. Should we have the opportunity to publish over 30,000 more papers on gun violence? Absolutely. Because I can’t tell you if more guns or less guns or safer guns or more training or anything will keep men women and children from being gunned down by individuals hell bent on destroying the world around them but unless we try and find out what we can do we are powerless to do anything. It’s like telling pregnant women not to go outside or just avoid travel to Zika areas…sometimes you need to go outside and Zika might just come to your area. And then you need to know what best to do for yourself and your family. You need to know what you don’t know.

So, on this Father’s day, I am thankful for a father who loved to hunt but always made us feel safe and secure when we went with him. For a father in law who loves to travel and has been generous to take us with them. And for a husband who loves his daughters, and everyone else around him for that matter, enough to work hard to bring more peace to the world on a weekly basis.

Wow. What a week it has been. I had been prepping to write something on Zika virus, which, as you can imagine, is hard to put a theologic spin to…but I feel overwhelmingly obligated to discuss the newsworthy yet tragic events of the last few days and weeks. Unless you don’t do the internet…which means you wouldn’t be reading this blog, you know that former Stanford student and swimmer Brock Turner was convicted of sexually assaulting a woman and then only sentenced to 6 months in jail, of which it seems he will likely serve 3. If you haven’t read the victims 12 page letter, please do. Your eyes will well with tears, your insides will hurt, your ears will sting and you will have some tiny insight in what it means to be victimized and humiliated. If you haven’t a clue about the prevalence of sexual assault, you can read this blog post and get just a bit of insight. The outcry against this young man’s sentence has been appropriately broad and loud.

There won’t be much medicine in this post. Instead, my mind has been brewing over the question…what does it mean to be merciful? When I read about tragedy or see it lived out before my own eyes the word that comes to the forefront of my mind is mercy. A word that conjures many emotions but I find difficult to define. So, like any gal in this decade, I texted my church girls and asked what they though it mean to be merciful. Here’s what they said.

“Good ole’ Webster: compassion or forgiveness shown toward someone whom it is within one’s power to punish or harm.” (of course from an educator). The other answers were some variation on this. Interestingly this followed a lengthy “discussion” (via text) on power previously in the day. So I asked myself, what does it mean to be merciful in the Stanford assault case? Where does compassion lie when someone has no remorse, no awareness of what they have done and what they have destroyed? What does it mean to be merciful to the victim? To her sister?

And then today 50 people were murdered and another 50 plus were injured in Orlando by a man with an agenda of hate. We can all speculate on who and what that hate was about but I think it would be hard to argue that this wasn’t motivated by hate. Is there a place for mercy in this situation?

You see, we all hold positions of power at some point in our lives. We might have authority at our job, with our children, or something as simple as being waited on in a place of service such as a restaurant. I think how we hold that power is key. We can clutch it tightly and find the best way to punish our enemies and fuel fear and hatred or we can hold it gently in our outstretched palm and exercise a judgement that is fueled by compassion and forgiveness. Sounds easy, right? (kidding.) I believe we can be merciful without sacrificing justice for the victims around us. DISCLAIMER: I don’t excel at mercy. I’m pretty good at judgement. Professionally, I try hard each day to ensure I give power back to people. That patients feel like they have a voice and that what they say matters and I see them as an individual who matters. I’m certainly not perfect at it. Personally, I find it much easier to judge the people in my social circles than to extend mercy. I want to be confessional so you’ll understand I find this as difficult as you.

So what does that look like? For the Stanford assault case, I think mercy for the victim is a prayer that says she will forgive herself each time she has a passing thought that maybe she deserves some blame. For the young man I think a place of mercy is much more difficult to find. Maybe it’s a prayer that instead of absolving him of responsibility and judgement, his eyes will be open to the breadth of damage he has caused with the crime he has committed. Where is mercy in Orlando? I believe it’s compassion for groups of people who have been victimized over and over again and often have no power in our culture. In both circumstances I think mercy is finding a way to ensure that we know and understand how best to gently handle a position of power and to teach those around us that same meaning.

The truth is I really don’t know in these tragic situations and others like it how to find myself on the side of mercy. The quote at the top of this blog from Pope Francis is overwhelming to me. But it is the truth. May we learn to extend mercy to our enemies. Maybe then they will do the same and the world will have a smidgen less hate in it. May we teach our sons (and our daughters) about mercy so that they will know how gently power is to be held. Maybe then when a young man sees a vulnerable young lady he will think protection instead of victimization. I don’t think mercy is about protecting ourselves, I think mercy is about protecting others from the harm we and others around us might do to them. Not with raised fists and weapons but with love and forgiveness for others. To strive to understand the other, our enemy, our opposite and to teach those around us to do the same. To give the nameless and faceless victim a voice.

I know it’s a long shot, but I am convinced that if we experienced mercy and showed it to others then maybe we would understand what it means to lay down power. We might see less guns and more reading programs. We might see safer college campuses. We might lower our voices during the political season to listen and learn. You see, extending mercy means you understand the person standing across from, whom you have power over, not as object but as subject. Someone who deserves to be extended compassion and forgiveness. I wonder if Brock Turner understood mercy he would have seen his victim as a person instead of an object to be owned and used. Finally, may we be merciful with ourselves when we find no capacity to think of forgiveness when confronted with hate-filled crimes and injustices that we see in the world around us. May we ask for mercy from those who we have exercised power against wrongly. We should exercise forgiveness continually and may it spur us to practice a prayer my dear friend sent to me today. “Jesus Christ son of God have mercy on me.”

(top photo credit to catholic.org who has an entire website dedicated to memes…who knew? The other two images are from the Instagram account of the official Nazarene church)

I took a few days off from work last week. It was a bit overdue. I told my residents that when I wore black pants to work every day for a solid week and didn’t brush my hair any of those days that it was probably symbolic of my attitude and maybe I should take a few days away. No one disagreed with me.

We spent a few days at a retreat at the lake. Some lovely pastors we know invited us and we took the kids. There was a lot of doing not so much. I brought my obsessively large stack of notecards and began to fill my days with scratching out barely legible notes to many of those people that impact me on a daily and weekly basis. I enjoy writing but also enjoy picking out just the right card, putting the stamp on and making sure my address book is up to date. It’s a ritual that puts my heart and mind in a good place. We came home and then I was fortunate enough to spend the weekend with wonderful friends who took the time to celebrate me growing a year older.

I have been reminded this past week what it really means to care for someone. I think we all feel pretty good about caring ABOUT someone but what does it mean to care FOR someone? Pastor Jon and Pastor Jason do it well, especially crisis care. People are sick, people are hurting, people are dying physically or emotionally…they come to their side and care deeply for them in ways that impact not only that person but their family and friends. Crisis care is deeply important. In medicine we often see people in crisis and are able to come and assist in the restoration of healing and wholeness. Crisis care can be very simple for physicians such as prescribing an antibiotic to someone who is sick and hurting or it can be very difficult at times such as performing a surgery on someone very sick or dealing with a worsening chronic illness. But the thing about crisis care is that you are very aware of the person’s needs. You get the page, the phone call, the text. Your mind starts working even before you look to see from whom or from where the noise came. (For Pastor Jason and I when the electronics start beeping at certain hours of the day or night we give each other “the look.”)

What is much more difficult is to care deeply for those NOT in crisis. To create a culture where we practice the art of caring on a regular basis. Why? I think because when we truly care for people we change the world for the better. To care for everyone who walks through the door of my office even if it is the 15th time I have seen them, even if it is a “routine” visit, even if I think I know all that is going on in their life. I heard a beautiful sermon today reminding me what we are capable of when we truly care deeply for others. When we refuse to keep each other at arms length and move close enough to see the worry lines creep in on someones face, to hear the anxious tremor in their voice, to notice the joy in their eyes. To take their hand, to give a hug and know that caring for others deeply will not only change them but it will change us too.

I write notes not only because the task itself brings me great joy but because it makes me carefully think about who I see and interact with on a regular basis. To examine the people around me who are bobbing along with the waves of life and have the opportunity to remind them that they are cared for deeply. I challenge my friends in healthcare to care deeply for their patients and coworkers, despite the struggle just to keep up with the enormous work we are tasked with. I challenge my friends at church and beyond to move away from a life of fear of what others will do or say and move to place where we ask questions, send notes, have coffee and listen. Listen and care deeply for our neighbors, our friends, and even our enemies and our opposites. So the next time you see a someone wearing all their black pants in one week or who has unbrushed hair 5 days in a row, it may not be a crisis, but an opportunity to care deeply for another.